VCU DEATH AND COMPLICATIONS CONFERENCE Introduction Complication Pancreaticojejunal anastamotic leak, UTI, sepsis Procedure Pylorus preserving pancreaticoduodenectomy Primary Diagnosis Pancreatic cancer Clinical History: LH # 77 yo male presenting with anorexia, weakness, painless jaundice and weight loss PMH Htn, TIAs, PVD, Hypercholesterolemia, colonic polyps PSH Right CEA, iliac stenting, transverse colectomy LH # Alert, significant jaundice, NAD RRR, no mrg Lungs ctab Abd soft, NT/ND, + BS, no masses Tbili = 20.7, Ca 19-9 = 1 LH # Given preop bowel prep and oral vitamin K 12/12 underwent pylorus preserving Whipple No metastatic disease No vascular invasion, margin on SMV close Invagination technique used for pancreaticojejunal anastamosis, gland moderately soft Interrupted choledochojejunal anastamosis Hand sewn duodenojejunal anastamosis Feeding tube placed distal Invagination PJ anastamosis LH # Initial course proceeded well Flatus by day 5, BM day 7, JPs serous Urinary retention following foley removal x2 requiring reinsertion Day 7 diet advanced to full liquids Preparing for discharge the following day On afternoon rounds patient noted to be hypotensive to 60 systolic with dark brown drainage from JPs Transferred to ICU, pressors, recuscitation CT scan obtained LH # Pt weaned off pressors within 24 hours, no renal failure Cultures revealed Enterobacter cloacae in blood and urine Failed to progress with continued drainage from JPs of 500cc/day Tube feeds started with return of bowel function CT on 12/30 revealed undrained collection, contrast extravasation from J tube, percutaneous drain placed, TPN initiated Pt currently on floor progressing slowly (malnutrition, debilitation) Pancreaticoduodenectomy Operative mortality